Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Monday, July 30, 2007

It's a big country

And in many ways, it's more than one country. The Commonwealth Fund has come out with it's periodic state scorecard on health system performance, and let me put it this way: You don't want to live in Texas, Mississippi, or Oklahoma, and if you do live there, you aren't likely to be living for a long time. The Fund ranks the states on the dimensions of access (percent uninsured); quality (based on indicators such as percentage of people receiving appropriate preventive care, and hospital quality indicators, percentage of people who have a regular primary care provider, and certain more esoteric indicators such as the percentage of nursing home residents who are restrained);avoidable hospital use (admissions for pediatric asthma, nursing home admissions, etc.); and mortality susceptible to health care.

What is interesting about all this -- apart from a marked tendency to see those blue states at the top and red states at the bottom -- is that all of these dimensions are highly correlated. If everybody's insured, you also have higher quality, and healthier, longer-lived people. Of course, that makes you a Marxist, or at least that's what Mitt Romney says about Hillary Clinton. (Utah, by the way, is right in the middle at 24 overall, but that's because they're near the bottom in access, quality, and equity, but they make up for it in avoidable hospital use and longevity because the Mormons don't smoke or drink. Utah is always an outlier in these kinds of analyses for that reason. If we could just end tobacco addiction forever . . . )

I'm proud to be able to say that all six of the New England states are in the top ten, but Hawaii is the overall winner. The bottom ten? Alabama, Georgia, Florida, West Virginia, Kentucky, Louisiana, Nevada, Arkansas, Texas, Mississippi, Oklahoma. Think about it.